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Ecosse Luc Lamoureux, Ryan Eyn Kidd Man, Eva Katie Fenwick, Alfred Tau Liang Gan, Charumathi Sabanayagam, Kumari Neelam, Preeti Gupta, Tien Yin Wong, Ching-Yu Cheng; Impact of incidence and progression of diabetic retinopathy on visual functioning in Singapore. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1357.
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© ARVO (1962-2015); The Authors (2016-present)
Data on the longitudinal impact of ocular diseases on patient-reported outcomes are rare at a population-based level worldwide. We investigated the independent impact of incidence and progression of diabetic retinopathy (DR) on visual functioning (VF) in Singapore.
In this population-based cohort of Singapore Indians aged 40-80 yr. (baseline 2007-2009; and follow-up 2013-2015), those with diabetes, clinical data, and VF information at both time points were included. Incident DR was defined using the Modified Airlie House classification as ‘none or minimal’ DR at baseline and at least mild DR at follow-up; incident vision-threatening DR (VTDR -severe non-proliferative DR; proliferative DR; and/or clinically significant macular edema) as no VTDR at baseline, and present at follow-up; and DR progression as at least one-step worsening in DR at follow-up from minimal or worse at baseline. VF-11 scores were converted to interval-level person measures (in logits) using Rasch analysis. The longitudinal associations between incident DR and VTDR; DR progression, and change in VF were assessed using multivariable linear regression models, adjusted for traditional confounders.
The response rate at the follow-up visit in those with diabetes was 59%. Of the 545 participants (mean age±SD 59.8±9.0 yr.; 48.1% female) included in the analysis, 21 (6.0%), 13 (2.5%) and 26 (17.8%) had incident DR, incident VTDR and DR progression, respectively, at follow-up. In models adjusting for age, gender, other eye conditions, socioeconomic status, and diabetes duration, those with incident DR and VTDR had a 33% (β=-0.52; CI [confidence interval] -0.91, -0.14; p=0.008) and 55% (β=-0.89; CI -1.47, -0.30; p=0.003) reduction in VF change scores, compared to those without these two conditions, respectively. Results were almost identical when presenting visual acuity was included in the model. Progression of DR was not independently associated with change in VF (β=-0.02; CI -0.61, 0.56).
Incident DR has a considerable negative impact on people’s vision-dependent daily living activities particularly in its late stage and our findings reinforce the need for strategies to prevent or delay the development of DR. Outside of visual acuity, other aspects of the visual system i.e., depth perception, may contribute to poorer life quality and need to be further investigated.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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